Gastroenterology Flashcards
What are some mechanical causes of dysphagia?
Malignancy Peptic stricture Lung cancer Retrosternal goitre Pharyngeal pouch
What are some motility causes of dysphagia?
Achlasia
Oesophageal spasm
Bulbar palsy - Parkinson’s, myasthenia
What are some causes of benign peptic stricture?
GORD, surgery, radiotherapy
What is oesophageal achalasia?
Loss of coordinated peristalsis
Lower oesophageal sphincter fails to relax
Dysphagia, regurgitation and weight loss
What are some differentials for nausea and vomiting?
Pregnancy, raised ICP
Gastric stasis
Small bowel obstruction
Gastroenteritis
What are some red flags for dyspepsia?
Anaemia Loss of weight Anorexia Recent/progressive Meleana Swallowing issues
What is the treatment for H pylori?
PPI e.g. lansoprazole
2 x antibiotics e.g. amoxicillin and clarithromycin
Review after 4 weeks
What is Zollinger-Ellison syndrome?
Peptic ulcers and gastrin-secreting adenoma (usually on pancreas)
Diagnose with serum gastrin level
Abdominal pain, dyspepsia, chronic diarrhoea
What are the types of hiatus hernia?
- Sliding - junction slides into chest
2. Rolling - bulge of stomach herniates into chest
What should be done initially for a suspected upper GI bleed?
ABCDE
Rockall score for risk
Check for signs of liver disease
PR for meleana
What are varicies?
Submucosal venous dilation secondary to increased portal pressures
Need endoscopic banding and B-blockade
What are some causes of portal hypertension?
Cirrhosis, schistosomiasis
Budd-chiari syndrome, right heart failure
What are some causes of dysentery?
Campylobacter Shigella E coli IBD Cancer
What blood tests should be done for chronic diarrhoea?
FBC
ESR and CRP
UEs
TFTs
What features of infective diarrhoea indicate need for prompt culture?
Fever >39
Dehydration
Blood in diarrhoea for over 2 weeks
What are the features of clostridium difficile infection?
Diarrhoea with systemic upset - high CRP and WCC, low albumin
Can lead to toxic megacolon and multi-organ failure
What are some differentiating features of ulcerative colitis?
Large bowel only
Continuous lesions
Non-smokers
What are some differentiating features of Crohn’s?
Mouth - anus Skip lesions Granulomas Smokers Abscesses and fistulae
What are some non-bowel signs of IBD?
Clubbing Aphthous ulcers Erythema nodosum, pyoderma gangrenosum Conjunctivitis, episcleritis, iritis Ankylosing spondylitis
What are the treatments for ulcerative colitis?
Mild: 5ASA e.g. mesalazine
Moderate: prednisolone
Severe: admit, IV fluids and steroids
What are the treatments for refractory IBD?
Immunomodulation e.g. azathioprine
Biologics e.g. infliximab
UC: subtotal colectomy and terminal ileostomy
What are some causes of malabsorption?
PBC
Cystic fibrosis
Giardiadiasis
Ileal resection
What are the diagnostic criteria for IBS?
Recurrent abdominal pain + 2 of:
Relief by defecation
Altered stool form
Altered stool frequency
What is the treatment for IBS?
Constipation: increase fluid and fibre, laxatives
Diarrhoea: avoid sweetners, caffeine, alcohol, low fibre, bulking agent
Colic/bloating: antispasmodics, probiotics, low FODMAP
What is scurvy?
Vitamin C deficiency
Anorexia, cachexia, gingivitis, halitosis
What does thiamine deficiency cause?
Wernicke encephalopathy - confusion, ataxia, ophthalmoplegia
Korsakoff syndrome - confabulation, lack of insight and apathy
What is pellagra?
Nicotinic acid deficiency
Diarrhoea, dementia, dermatitis
What increases the risk of pancreatic carcinoma?
Smoking, alcohol
DM, chronic pancreatitis
Adiposity
What are carcinoid tumours?
Tumours of endochromaffin cells - neural crest cells
Capable of producing 5HT
Appendix, ileum, rectum
What is carcinoid syndrome?
Bronchoconstriction
Paroxysmal flushing
Diarrhoea
CCF
What is a carcinoid crisis?
Tumour outgrows blood supply
Life-threatening vasodilation, hypotension, tachycardia, bronchoconstriction and hyperglycaemia
Give high dose actreotide
What are some causes of pre-hepatic jaundice?
Haemolysis - malaria, DIC< hereditary
Gilbert’s
What are some causes of hepatic jaundice?
Viruses, EBV
Paracetamol overdose, statins, alcohol
Hepatocellular carcinoma
Haematochromatosis, Wilson’s, Budd Chiari
What are some causes of post-hepatic jaundice?
PBC, PSC
CBD stones
Pancreatic cancer
What signifies liver failure?
Coagulopathy and encephalopathy
What are some signs of liver failure?
Asterixis/flap
Encephalopathy
CLD signs
What are some complications of liver failure?
Cerebral oedema Bleeding Ascites Infection Encephalopathy
What is hepato-renal syndrome?
Cirrhosis + ascites + renal failure
What are the signs of chronic liver disease?
Clubbing, palmar erythema, dupytren’s
Jaundice, telangiectasia
Gynaecomastia, loss of axillary hair
Bruising, hepatomegaly, distension, caput medusae
What investigations should be done for suspected cirrhosis?
LFTs, INR, WCC Hepatitis serology, immunoglobulins, autoantibodies USS Ascitic tap Biopsy
What are some complications of cirrhosis?
Spontaneous bacterial peritonitis
Portal hypertension
HCC
Liver failure
What are some features of hepatitis A?
Faecal-oral spread, shellfish
IgM = recent exposure
IgG = exposure sometime in life
Usually self-limiting
What are some features of hepatitis B?
Blood and sexual spread HBsAg = exposure HBeAg = acute infection HBcAg = past infection Can cause cirrhosis
What are some features of hepatitis C?
Blood and sexual spread
anti-HCV Ab = exposure
HCV-PCR positive = chronic infection
25% progress to cirrhosis
What are some features of hepatitis D?
Needs HBV
Can cause acute liver failure
What are some features of hepatitis E?
Faecal oral spread
Increased mortality in pregnancy
What types of hepatitis can be vaccinated against?
A and B
What are the different types of alcoholism?
Binge drinking
Alcohol abuse
Alcohol dependency
What are some clinical features of delirium tremens?
Tachycardia, hypotension, confusion, fits, hallucinations
What are the stages of primary biliary cirrhosis?
- Interlobular bile ducts damaged by autoimmune granulomatous inflammation
- Cholestasis
- Fibrosis, cirrhosis and portal hypertension
What antibody signifies PBC?
Anti-mitochondrial antibodies
What is primary sclerosing cholangitis?
Progressive cholestasis with bile duct inflammation and strictures
Leads to ascending cholangitis and cirrhosis
High IgM
What is autoimmune hepatitis?
Abnormal T cell function and antibodies against hepatocyte surface antigens
Usually young women
What antibody signifies autoimmune hepatitis?
Anti smooth muscle antibodies
What is Wilson’s disease?
Autosomal recessive disorder of copper excretion
Accumulates in liver then later brain
What are the signs of Wilson’s disease?
Liver disease in children
CNS signs in adults - tremor, dysarthria, dystonia, dementia
Depression, mania
Kayser-Fleischer rings
What is the treatment of Wilson’s disease?
Avoid copper rich foods
Lifelong penacillamine
Monitor FBC and urinary copper
Genetic testing
What cancers metastasise to the liver?
Breast
Bronchus
GI tract
What is hereditary haemochromatosis?
Disorder of iron metabolism
Increased intestinal absorption - joints, liver, heart, pancreas, pituitary, skin, adrenals
What are the signs of haemachromatosis?
Arthralgia, tiredness
Slate grey skin pigmentation, CLD, dilated cardiomyopathy
DM, hypogonadism
How is haemochromatosis treated?
Maintenance venesection
Monitor LFTs and blood glucose
What is alpha-1 antitrypsin deficiency?
Inherited disorder affecting lung and liver
Can lead to emphysema and cirrhosis
